Use of Telehealth in
Concussion Rehab

Based on a presentation given by Cheryl Mitchell, PT, DPT, Astym, Concussion Cert, SFMA, Founder of Inspiration Physical Therapy and Consulting, at the
2022 Concussion Care Virtual Conference.

Concussion Basics

What is a concussion?

Concussion is a disturbance in brain function that can be caused by a direct or indirect blow to the head or elsewhere on the body. A concussion is a functional injury, not a structural injury. That means that a concussion won’t show on an MRI or CT scan.

What are the types of concussion?

Cortical concussion - concussion of the brain
Labyrinthine concussion - concussion of the inner ear

Patients can have both or just one type of concussion at once.

Who does a concussion affect?

The short answer is, concussions can affect anyone. Some common causes of concussion include:

  • Motor Vehicle Accidents (MVA)
  • Sports
  • Falls
  • Fights or physical contact
  • Assaults
  • Blasts from explosives

What are risk factors for prolonged concussion recovery?

There are certain risk factors that will indicate a longer concussion recovery, including:

  • History of prior concussions
  • History of eye tracking issues
  • History of migraines
  • Attention Deficit Hyperactivity Disorder (ADHD) or associated syndromes
  • Learning disabilities
  • History of mental health disorders

What are the symptoms of a concussion?

Common symptoms of concussion include:

  • Brain fog or “just not feeling right”
  • Light / noise sensitivity
  • Difficulty concentrating
  • Difficulty remembering
  • Dizziness
  • Difficulty sleeping or falling asleep
  • Mood / emotional changes
  • Headache
  • Blurred vision
  • Feeling slowed down
  • Fatigue / low energy
  • Confusion
  • Drowsiness
  • Irritability
  • Nervousness / Anxiety
  • Pressure in the head
  • Nausea or vomiting

Use of Telehealth in Concussion Rehab

What are the challenges of traumatic brain injury (TBI) patients attending in-person sessions?

Transportation - Patients with concussion may not be able to drive due to symptoms and not everyone will have a caretaker to give them a ride. Additionally, the act of being in a car may flare up symptoms.

Over stimulation in the clinic - Environmental factors in the clinic, such as light and sound, may trigger patients’ symptoms. Patients may be left feeling cognitively drained after appointments.

What are the benefits to using telehealth for concussion rehab?

The biggest benefit of telehealth for concussion rehab is that patients have increased access to care. They experience less triggers which provides the opportunity for more frequent sessions. They also save time by not having to drive to appointments, especially for patients who live far away from the clinic. This gives them more time to do the things that bring them joy. They also get to reserve energy and stamina so they’re not as exhausted after appointments.

Depending on the patient’s situation and ability to get to the clinic, a hybrid approach may be beneficial. In this case, you can plan to use in-clinic sessions to do manual techniques and balance training, and use telehealth sessions for cognition, strength, range of motion (ROM), flexibility, and education.

When conducting telehealth sessions, use your best clinical judgment for functional activities and always keep patients’ safety as your top priority. You’re not physically there to catch them, so it’s always best to err on the side of caution, especially for any balance activities.

How do you assess a concussion via telehealth?

At a minimum, your telehealth concussion assessment should include:

  • ROM tools
  • Functional measures
  • SFMA
  • Movement analysis
  • ImPACT
  • Vestibular assessment
  • Cognitive assessment

How can you treat concussion via telehealth?

Some concussion treatments that can be done via telehealth include:

  • Cognitive treatments
  • Vestibular treatments
  • Musculoskeletal treatments
  • Balance treatments
  • Education

Always follow up with handouts because concussion patients may have a hard time remembering your verbal instructions. These may include the patients’ Home Exercise Program (HEP), education, and recommendations for home environment and possible modifications.

Reimbursement for Concussion Rehab via Telehealth

Most insurances have provisions for telehealth coverage. Every insurance and sub-plan is different, so make sure you call and confirm whether they cover telehealth.

Some insurances require the use of a HIPPA compliant platform while others do not. HIPPA compliant platforms include doxy.me, MedBridge, and BlueJay. Many EMR systems have also developed their own HIPPA compliant telehealth platforms.

Billing for telehealth visits is the same as billing for in-clinic visits. Common CPT Codes that can be billed for concussion rehab via telehealth include:

  • 97161-97163: Eval codes (untimed)
  • 97530: Therapeutic activities
  • 97535: Self care / home management
  • 97112: Neuromuscular education
  • 97110: Therapeutic exercises
  • 97116: Gait training

In 2022, CMS introduced new Remote Therapeutic Monitoring (RTM) Codes:

  • 98975: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment.
  • 98977: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g. daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, every 30 days
  • 98980: Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes
  • 98981: Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes

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